Spine experts have their eyes on codes that they want to see reformed.
1. Bone-anchored annular closure: The International Society for the Advancement of Spine Surgery updated its 2025 policy recommendations for bone-anchored annular closure in high-risk discectomy patients. The organization’s recommendation accounts for new five-year data showing significant reductions in symptomatic reherniation, reoperation, and device-related adverse events. Intrinsic Therapeutics’ Barricaid device for the procedure also has CPT and ICD-10 codes in place, and ISASS’ update urges coverage and appropriate clinical adoption.
“Discectomy alone leaves a structural vulnerability in high-risk patients,” Morgan Lorio, MD, ISASS past president and chair emeritus of the Coding & Reimbursement Task Force said. “Bone-anchored annular closure addresses that gap — reducing repeat surgeries and sustaining long-term outcomes.”
2. Decompression with placement of inner spinous spacer: Dr. Lorio said the code was expanded to include devices besides Coflex that are seeking FDA approval, but remains undervalued.
“Because it was undervalued, the device flatlined relative to sales and because of it being bundled rightly or wrongly, it puts it at odds with codes that some entrenched societies don’t want touched, potentially in terms of reconsideration through the RUC process,” Dr. Lorio said. “As such, when this code is analyzed, it’s not shown in the best light, and the work is not appreciated. I think the newer products that are developing under this code descriptor, actually involve more time than Coflex, and hopefully we can get that re-assessed in the near future.”
3. Endoscopic lumbar decompression: Dr. Lorio and Kai-Uwe Lewandrowski, MD, suggest retiring CPT code 62380 entirely in a report for the July 2025 issue of International Journal of Spine Surgery. Other spine surgeons agree.
“The purpose of the procedure is to unobstruct/decompress a nerve root that is being obstructed, distorted or compressed, whether it be by a herniated disc, thickened ligament, a bone spur or a cyst,” spine surgeon, Ezriel Kornel, MD, said. “The tools used are not the fundamental issue and an endoscope is simply a tool. We don’t have to have a special code when using a pituitary ronguer for example. The complexity of the case is not about the visualization or the tools but rather about the job that needs to be done. The surgeon can always use a modifier code if they feel that the procedure is more complex and difficult and time consuming then the standard approach. By the way, only a surgeon qualified in using a variety of surgical approaches to enter the spine should be qualified to use this endoscopic approach as well. Furthermore an add-on code could be utilized for the endoscope just as it is for the microscope.”
